Résumés
Résumé
Le trouble obsessionnel-compulsif (TOC) est une condition invalidante pour laquelle l’exposition avec prévention de la réponse (EPR) constitue le traitement psychothérapeutique de première ligne. Malgré des données probantes solides, de nombreuses personnes atteintes n’ont pas accès à des interventions spécialisées, ce qui contribue à des trajectoires de soins longues, coûteuses et souvent peu efficaces. Ce cas décrit l’évolution d’une usagère de 66 ans présentant un TOC de plus de 40 ans, ayant participé à un programme intensif spécialisé en EPR offert dans un centre de santé universitaire. Les évaluations prétraitement, post-traitement et au suivi à 2 mois portaient sur la sévérité des symptômes, l’impact fonctionnel, l’acceptabilité du traitement, les attentes de changement et la disposition à tolérer l’inconfort associé aux expositions. Après 2 semaines d’intervention intensive, une diminution marquée de la sévérité du TOC, une amélioration significative du fonctionnement quotidien et une réduction notable des rituels ont été observées. Ces gains cliniques se sont maintenus et consolidés au suivi à 2 mois, en parallèle d’une confiance soutenue envers le traitement et d’un engagement durable dans les stratégies d’exposition. Ces résultats s’inscrivent dans la littérature démontrant l’efficacité des programmes intensifs, y compris pour des TOC de longue durée. Ce cas souligne l’importance de développer des services spécialisés pour le TOC au Québec et de former davantage de cliniciens aux approches fondées sur les données probantes. Il rappelle également que la chronicité du TOC n’est pas synonyme de résistance thérapeutique, mais plutôt d’un accès insuffisant à des interventions adéquates.
Mots-clés :
- trouble obsessionnel-compulsif,
- exposition avec prévention de la réponse,
- traitement intensif,
- étude de cas,
- services spécialisés
Abstract
Obsessive–compulsive disorder (OCD) is a disabling condition for which exposure and response prevention (ERP) is the first-line psychotherapeutic treatment. Despite strong evidence supporting its efficacy, many individuals with OCD do not receive specialized care, resulting in lengthy, costly, and often ineffective treatment trajectories. This case report describes a 66-year-old woman with a more than 40-year history of OCD who participated in an intensive, specialized ERP program delivered within a university hospital setting. Assessments conducted at pretreatment, post-treatment, and at a 2-month follow-up examined symptom severity, functional impairment, treatment acceptability, expectations for improvement, and willingness to tolerate discomfort associated with exposure-based work. Following two weeks of intensive intervention, the patient demonstrated a substantial reduction in OCD symptom severity, marked improvements in daily functioning, and a significant decrease in ritualistic behaviors. These clinical gains were maintained and further consolidated at the 2-month follow-up, alongside sustained confidence in the treatment approach and continued engagement in exposure-based strategies. These findings are consistent with evidence supporting the effectiveness of intensive ERP programs, including for individuals with longstanding OCD. This case underscores the critical need to expand access to specialized OCD services and to enhance clinician training in evidence-based interventions in Québec. More broadly, it illustrates that chronicity should not be equated with therapeutic resistance, but often reflects limited access to appropriate, specialized care.
Keywords:
- obsessive–compulsive disorder,
- exposure and response prevention,
- intensive treatment,
- case study,
- specialized services
Parties annexes
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